Thyroid Surgery

Surgery Overview

During surgery, an incision is made in the skin. The muscle
and other tissues are pulled aside to expose the thyroid gland.

What To Expect After Surgery

Many people leave the hospital a day or two after surgery. How much time you spend in the hospital and how fast you
recover depend on your age and general health, the extent of the surgery, and
whether cancer is present.

Why It Is Done

Surgery is used to treat thyroid
problems if:

Thyroid cancer is present or is suspected.

A noncancerous (benign) nodule is large enough to cause problems
with breathing or swallowing.

A fluid-filled (cystic) nodule
returns after being drained once or twice.

Hyperthyroidism cannot
be treated with medicines or radioactive iodine.

Surgery is rarely used to treat hyperthyroidism. It may be
used if the thyroid gland is so big that it makes swallowing or breathing
difficult or thyroid cancer has been diagnosed or is suspected. Surgery also
may be done if you are pregnant or cannot tolerate antithyroid
medicines.

You may have all or part of your thyroid gland removed,
depending on the reason for the surgery.

Total thyroidectomy. Your surgeon will
remove the entire gland and the
lymph nodes surrounding the gland. Both sections
(lobes) of the thyroid gland are usually removed. If you have thyroid cancer, additional treatments with
thyroid-stimulating hormone (TSH) suppression and
radioactive iodine work best when as much of the thyroid is removed as
possible.

Thyroid lobectomy with or without an isthmectomy. If your thyroid nodules are located in one lobe, your
surgeon will remove only that lobe (lobectomy). With an isthmectomy, the narrow
band of tissue (isthmus) that connects the two lobes also is removed. After the
surgery, your nodule will be examined under a microscope to see whether there
are any cancer cells. If there are cancer cells, your surgeon may perform a
complete thyroidectomy.

Subtotal (near-total) thyroidectomy. Your surgeon will remove one complete lobe, the isthmus,
and part of the other lobe. This is used for hyperthyroidism caused by
Graves' disease.

Some surgeons are now doing endoscopic thyroidectomies using several small incisions through which a tiny camera and instruments are passed.

How Well It Works

Success of a thyroidectomy to remove
thyroid cancer depends on the
type of cancer and whether it has spread (metastasized) to other parts of the
body. You may need follow-up treatment to help prevent the cancer from
returning or to treat cancer that has spread.

If a large noncancerous (benign) nodule causes symptoms, such as pain or problems breathing or swallowing, surgery may help relieve symptoms. All or part of the thyroid gland may be removed. Surgery may also help relieve symptoms if other treatments, such as draining a noncancerous nodule filled with fluid (cyst), have not worked. Surgery may also be an effective treatment if you have a thyroid
nodule that makes too much thyroid hormone.

Risks

Thyroid surgery is generally a safe surgery. But
there is a risk of complications, including:

Hoarseness and change of voice. The nerves that control your
voice can be damaged during thyroid surgery. This is less common if your
surgeon has a lot of experience or if you are having a lobectomy rather than a
total thyroidectomy.

Hypoparathyroidism. Hypoparathyroidism
can occur if the
parathyroid glands are mistakenly removed or damaged
during a total thyroidectomy. This is not as common if you have a
lobectomy.

What To Think About

If you have a total thyroidectomy,
you will develop
hypothyroidism and need to take man-made (synthetic)
thyroid hormone for the rest of your life. If you have a lobectomy or subtotal
thyroidectomy, you may have hypothyroidism and you may need to take thyroid
medicine for the rest of your life.

You will most likely be
treated with radioactive iodine after surgery for thyroid cancer to make sure
that all the thyroid tissue and cancer cells are gone.

You may
have a lobectomy, with or without isthmectomy, if your doctor suspects that a
nodule may be cancerous. If you do have cancer, a surgeon usually will do a
complete thyroidectomy.

After surgery for
hyperthyroidism, some people will have low calcium levels and may need to take
calcium supplements.

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